Consequences on mental health - Colombia's cycle of violence

27 April 2006

My mother cannot sleep... if she hears a motorbike out in the street she wakes up and cannot fall asleep again (...) the thing is that last week we had to pick up our brother-in-law. He was almost unrecognisable. They had beaten him up, and his head was chopped off. I can't get that image out of my head. — A young man living in an urban slum

Although it is commonly accepted that the majority of people "cope" with violence without developing a mental disorder, enduring intense suffering significantly reduces their daily functioning.
When speaking to psychologists, many people report feeling constant fear and anxiety, and react to it with insomnia, muscular tension, sweating, dizziness, palpitations, vertigo, or gastric problems. Those who recently experienced violence remain hypervigilant and experience anguish when they hear a motorcycle pass by, a dog's bark, or footsteps in the street.
Half of the consultations done by MSF psychologists in urban slums in Sincelejo and Ovejas are triggered by experiences of violence. Of those, 41% are related to acts of violence perpetrated by armed groups involved in the conflict. Many of these patients have directly witnessed the murder of a family member (37%), or have had close relatives disappear as a result of forced displacement (10%).
One of the most common consequences of violence is having to accept the death or disappearances of relatives and loved ones. Loss and mourning are some of the most common sources of suffering identified by MSF psychologists. The most complicated mourning processes are those in which the relatives have witnessed the murder of family members.
"Some men came around the house asking for my son. We called him and we continued doing our own thing. They took him out and then we heard gunshots. My grandson ran out to see what happened, and he was shot too.
"There he fell, next to his dead father... We were terrified and we did not dare to come out of the house. The child was crying outside and my wife wanted to go and pick him up, but I told her to stay in, because she was going to be killed too. She managed to pull herself out of my arms and ran out, and the child was there, all covered in blood, telling his dad to get up. I have those memories and I cannot get rid of them. Why did this happen to us if we did not owe anything to anyone?"
— A grandfather living in an urban slum
Coming to terms with someone's disappearance is equally complicated. Family members suffer greatly when they do not know if their loved ones are dead or alive. Surviving relatives who have not been able to bury a body (in cases in which the body has never been found) endure extreme pain when confronted with the thought of the body of their child left in a garbage dump or buried in a mass grave.
Many of MSF's mental health consultations (22%) fall under the category of "family problems". These problems affect all kinds of people, both long-standing slum residents and those displaced by violence. Longer-term interaction with clients reveals that many of these problems are linked with past incidents of violence and forced displacement. Relationship problems, domestic and family violence, children with dysfunctional behaviours at school, alcohol and substance abuse, are all likely to be manifestations of a context in which individuals and families are deprived of stability, welfare, job opportunities, and income.
The decision to return 'home' Most people live as displaced in the slums for the rest of their lives, struggling to make ends meet, enduring neglect and deprivation. Even after many years, however, some families still think back to their lives before displacement, and dream about returning 'home' to their land and former lives.
"Some people say it is not really safe back home, but we are sick and tired of this life in the slums... After all these years we are still displaced, as displaced as when we first arrived. We are neither from here nor from there. At this point, we would rather take risks and go back home, and see if we can regain part of what we lost."
— Male, head of a family of six